Tuesday, April 29, 2014

ABIM Thumbs Its Nose at Senior US Physicians

Yesterday, the President and CEO of the American Board of Internal Medicine (ABIM), in a moment that must have been heartbreaking for him, found himself in the position of having to chasten more than 10,000 unruly senior US physicians, thanks to a petition drive.  In his statement, the aggrieved Dr. Baron, in a plea for common sense, bemoans the fact that physicians do not care enough about patient care or safety to spend $200-400 dollars per year for the ABIM.  This is what the benighted ABIM is up against!  Senior physicians are nothing more than penurious whiners who fail to be appreciative of the Mothership.

For those cynics out there might cast a jaundiced eye on the image of the ABIM as the Mothership,  let's not forget the sterling flotilla that the Mothership floats with.  Recall that the ABIM rides in the wake of the American Board of Medical Specialities (ABMS).  Recall that both the ABIM and ABMS arose from the shipyard of the Amedican Medical Association (AMA)  that produces the trademarked CPT procedure codes that Electronic Medical Record industry celebrates.  Recall that Dr. Baron hails  from the Center for Medicare and Medicaid Services.  Recall that the former president of the ABIM, Christine Cassells, had an exemplary friendship with Premier, Inc, a North Carolina company that provides group purchasing and performance improvement consulting for an alliance of 2,900 hospitals and Kaiser Foundation Health Plans and Hospitals. With these kind of credentials, physicians should trustingly take their hands off the policy rudder and know that their profession is secure.

How could doctors doubt the purity of the Mothership?  Given their tireless efforts on the behalf of physicians and our patients, we should, in fact, be holding a fund-raising drive for the ABIM!  How can we be unsympathetic to the responsibility and burden of reimbursing the ABIM's necessary expenses, such as Doctor Baron's $800,000 annual salary or the bottom line of their testing agency?  Don't doctors know that they are singlehandedly preserving the integrity of our specialties and subspecialties that the rest of us would squander willy nilly?

I'd like to reassure President Baron.  It appears we've reached a tipping point.  Physicians are starting to understand the need for active advocacy in protecting our patients and our medical profession.   Disturbingly for the current regime who have commandeered the dignity of practicing physicians for their own benefit, there are appear to be heavy seas ahead.

-Wes

10 comments:

  1. In his attempt at justifying the ABIM's activities,Dr. Baron references their Revenue and Expense report for Fy 2013. Revenue exceeded expenses by about $2.2 MILLION.Does that mean they had to save up their "profit" for 6-7 years to be able to give 13 million to the ABIM Foundation to promote the social justice of the new Professionalism.

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  2. Wes, my view is that Dr. Richard Baron’s comments on the ABIM website are eerily similar to the Democratic Party strategy of dealing with the ACA rollout debacle as it pertains to the 2014 November election. After all, the best defense is a good offense, articulated by means of clever doublespeak.

    Allow me to retort to a few of his official statements:

    “ABIM has heard from many diplomates about their frustrations...”
    -No Dick, we are not frustrated. We are outraged. Every indication is that there are 10,000+ (most likely many times that number) individuals who are frankly pissed off at you and your unaccountable cohorts.

    “...large numbers of internists have chosen to use the new MOC requirements to demonstrate to their peers and their patients that they are keeping up and engaged in ongoing assessment.”
    -Dick, most of us have ‘chosen’ nothing. No more so than you would ‘chose’ to hand over your wallet to an armed assailant pointing a gun at you on the mean streets of Philadelphia. Compulsion is a better word for it. What we are ‘demonstrating’ to our families, not ‘peers’ and ‘patients’, is the need to submit to this onerous task so that we do not lose our sole means of livelihood.

    “One of the biggest critiques I hear from physicians is that they should get credit for things they are already doing.”
    -Please Dick, we are not that naive to recognize that any ‘approved’ activity must enhance ABIM’s revenue stream. Otherwise, where would the 800K come from to pay your richly deserved salary?

    “There is a good deal of research demonstrating the value of MOC...”
    -And Dick, just who authors this ‘research’? The ABIM cohorts supporting their self interests? That makes about as much sense as contracting with a fox to design the security system of a chicken coop.

    “We have recently changed our governance structure so that all of our specialty boards include at least one internist in non-academic community practice as well as two public members...”
    -Dick, I am impressed. ONE whole internist who practices in the real world ought to provide balance to the opinions of a boat load of ivory tower egg heads who don’t know a whit about practicing in the real world. And just in case that ONE practicing internist gets too irksome, we can have him or her overruled by TWO members of the lay public who know nothing of the daily trials and tribulations of being a physician. Truly a PC coup! Now I feel all warm and tingly.


    Please sir, may I have another?

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  3. Testing our patients results in a rap on the knuckles of physicians with an insinuation of avarice, inappropriateness, and claims of 'not supported by the medical literature'.

    On the other hand, the never-ending testing of physicians 'assures society of quality medical care' despite the FACT that the literature cannot demonstrate said benefits.

    Ostensibly, what is good for the goose is not good for the gander. HYPOCRISY!!

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  4. Richard J. Baron MD: Thanks for your ABIM response (4/28/2014) to the American College of Cardiology petition against MOC. Physicians must pursue meaningful dialog. I am reminded of Peter Pan's playful song, "Don' t want to go to school. Just to learn to be a parrot… and besides a silly rule." Many of us became parrots to pass MOC and believe that medical competence and professionalism is better measured outside of MOC. I wrote to Dr Cassell about the ABIM's controversial twist of the Angoff test standard, as you might know. I discussed with her staff many examples of how MOC wandered away from clinical relevance in recent years. Basically, Board certified doctors resent and challenge MOC as a false credentialing standard. I can't blame ABIM for seizing new revenue lines and financial opportunities. But taxation without representation is tyranny. Testing and MOC mandates without the expertise of experienced, relevant night-call physicians is almost tyranny. MOC has become an affront to the noble profession and practice of medicine. Why would ABIM attack the competence of their own Board certified physicians so aggressively outside of easy revenue sources for an expanding business? Meanwhile, MOC has hurt US medicine in many ways. MOC promotionals have hurt previous good CME programs like MSKP. MOC has divided physicians and surgeons against themselves. MOC has divided older grandfathers from young and midcareer physicians struggling under MOC. MIC has destroyed collegiality in our hospitals. MOC has cut membership in specialty societies and in organized medicine. The harm of MOC to US medicine is great while the possibility of improving patient care in any way is highly controversial. Ten thousand doctors challenging MOC represent just the tip of an iceberg objecting to MOC.
    For each signature, thousands more physicians and surgeons support the cardiologists this March against MOC. We are Board certified lifelong scholars loving our careers as we pursue lifelong learning independent of MOC. We bemoan false claims from ABMS and ABIM against any Board-certified physician or sugeon labeling us incompetents after just 10 years unless we pay for your new MOC brand of tests and activities. We understand your large business, your high revenue, tax exempt testing industry and we understand your freedom to grow indefinitely as a recertification monopoly. But as you remove 10% or more of previously Board certified physicians and surgeons who give up MOC each year, have you considered how MOC might wrongfully compromise patient access to the best US physicians and surgeons? Are you not concerned that ever increasing and costly MOC mandates may compromise and hurt patient safety as your remove good doctors arbitrarily? Do you feel that MOC marketing is ethical for improved patient outcomes or for an improved US workforce when good doctors are kept off hospital staffs, out of universities, or otherwise shunned only because they withdrew from MOC? Perhaps CMS supports MOC as a means to shrink the physician workforce and expand the role of noctors and pharmacists as prescribing health care providers. Meanwhile, perhaps ABIM as a nonprofit might demonstrate its commitment to America's Board certified physicians by dropping MOC mandates; offer truly voluntary lifelong learning and MOC re certification activities as optional choices completely free of charge. Keep in touch.

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  5. I agree with the article and the comments. The fact they can be posted is at least one evidence there is still hope for some kind of representative voice.

    If academics feel they have truly identified some area of need, it would be a rather simple matter to have some kind of test administered periodically over the internet.

    If I wait to shop until I actually need something, I avoid waste. If I go into a store and just start shopping, I will blow money. If the Medical Board identified an actual clinical need and then devised a way to spread the news, that would be one thing, but shopping around for something to test, usually something so obscure they have to leave the specialty to find an expert, that is just shopping for something to test. Let us have testing on what doctors face and how others feel it might be addressed, and let it be free or with awareness of the time pressures in practice.

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  6. The ABMS needs to be defunded and their gang of vandals guarding the gates of access to medicine sent packing to do an honest days work elsewhere. I will recertify no more. If it means I cannot be a doctor anymore, than it is time for me to get out of this thankless profession.
    Jack Rzepka, MD

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  7. Agree with all you've said, and in addition would call Dr. Baron out on his gross underestimation of cost of MOC to physicians. My recent IM recertification cost me about $10,000 (fees, study materials, and time off needed to study). Even if you divide that up over the new 10 year plan, the cost would be $1000 per year, not $200...

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  8. There is a schizoid quality to the regulators. N.Y. has now made it law that nurse practitioners do not need association with a physician, claiming it serves "no clinical purpose". At the same time, the regulators are piling very tight requirements on physicians which come with a high price tag and huge annoyance factor. Why is this necessary if a nurse practitioner is supposedly up to the job of doing the very same thing?

    Time for the robber barons to back off?

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  9. Dr.Baron claims to be a leader in "phenomenology". Hard to imagine anything which is not a phenomenon. Here is a quote from one of Richard Baron's articles:

    "A great gulf exists between the way we think about disease as physicians and the way we experience it as people. Much of this separation derives directly from our basic assumptions about what illness is. Our medical world view is rooted in an anatomicopathologic view of disease that precludes a rigorous understanding of the experience of illness."

    Here is a comparable paragraph:

    "A great gulf exists between the way ABIM thinks about practice and the way we experience it as physicians. Much of this derives from basic assumptions about what practice is. The regulators world view is rooted in a politicolucrative view of practice that precludes a rigorous understanding of the experience of overregulated practice."

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  10. Great comments by all. Just an fyi,
    Ohio has a bill to further loosen supervision of nurse practioners.
    I don't believe this is coincidental , rather , coordinated attacks on practicing physicians.

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